Chapter 4: Infection prevention and control
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Source: Adapted from DH ([25]). © Crown copyright.
Source: DH ([25]) Health Technical Memorandum 07‐01: Safe Management of Healthcare Waste. Department of Health, London. Figure 11. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/167976/HTM_07‐01_Final.pdf
Waste disposal
Related theory
Waste material produced in the healthcare environment may carry a risk of infection to people who are not directly involved in providing healthcare but who are involved in the transport or disposal of that waste. All waste disposal is subject to regulation and hazardous waste is subject to further controls, depending on the nature of the hazard (DH [25]). To ensure that everyone involved in waste management is aware of, and protected from, any hazard presented by the waste with which they are dealing, and that the waste is disposed of appropriately, a colour‐coding system is used. The colours in general use are shown in Table 4.8.
Table 4.8 Waste colour codes
Colour | Description |
---|---|
Waste that requires disposal by incineration
Indicative treatment/disposal required is incineration in a suitably permitted or licensed facility. | |
Waste that may be ‘treated’
Indicative treatment/disposal required is to be ‘rendered safe’ in a suitably permitted or licensed facility, usually alternative treatment plants. However, this waste may also be disposed of by incineration. | |
Cytotoxic and cytostatic waste
Indicative treatment/disposal required is incineration in a suitably permitted or licensed facility. | |
Offensive/hygiene waste
Indicative treatment/disposal required is landfill or municipal incineration/energy from waste at a suitably permitted or licensed facility. | |
Anatomical waste for incineration
Indicative treatment/disposal required is incineration in a suitably permitted facility. | |
Domestic (municipal) waste
Minimum treatment/disposal required is landfill, municipal incineration/energy from waste or other municipal waste treatment process at a suitably permitted or licensed facility. Recyclable components should be removed through segregation. Clear/opaque receptacles may also be used for domestic waste. | |
Medicinal waste for incineration
Indicative treatment/disposal required is incineration in a suitably permitted facility. | |
Amalgam waste
For recovery. |
There are several different types of waste containers. They are usually plastic bags or rigid plastic containers of the appropriate colour (Table 4.9). Boxes for disposal of sharps are usually differentiated from rigid boxes for other waste.
Table 4.9 Waste containers
Waste type | Waste receptacle | Example descriptionc04-note-0003 | Waste management requirementsc04-note-0004 | Additional comments |
---|---|---|---|---|
Domestic type waste |
Black bag | Mixed municipal waste |
Landfill
Municipal incineration
Energy from waste
Other authorised disposal or recovery |
Medical practices must not place any hazardous waste in this waste stream.
Recycling options should be considered |
Offensive (healthcare) |
Yellow and black striped bag | Offensive waste from human/animal healthcare |
Landfill
Municipal incineration
Energy from waste
Other authorised disposal or recovery | This is restricted to offensive wastes from healthcare and related activities (including autoclaved wastes from laboratories) |
Offensive (municipal) | Offensive waste, municipal | This includes municipal hygiene wastes from medical practices | ||
Anatomical waste (chemically preserved) |
| Clinical waste, human/animal anatomical, chemically preserved, for incineration only | Clinical waste incineration |
If the waste is not classified as infectious (18 01 03* or 18 02 02*) then:
|
Anatomical waste (not chemically preserved) | Red‐lidded, rigid yellow container | Clinical waste, human/animal anatomical, not chemically preserved, for incineration only | ||
Infectious waste contaminated with chemicals |
| Clinical waste, infectious, containing chemicals from human/animal healthcare, for incineration only | Clinical waste incineration |
Waste chemicals must not be placed in this waste stream. It is for infectious materials containing or contaminated with chemicals (eg sample vials and used diagnostic kits) |
Infectious waste (not containing chemicals or medicinal contamination) |
Orange bag or Orange‐lidded, rigid yellow container | Clinical waste, infectious, from human/animal healthcare, suitable for alternative treatment | Alternative treatment or clinical waste incineration | This assumes healthcare offensive and domestic wastes are also segregated separately |
Sharps, non‐medicinally contaminated |
Orange‐lidded, yellow sharps box | Clinical waste, sharps, infectious, non‐medicinally contaminated, suitable for alternative treatment | Alternative treatment or clinical waste incineration | For producers and disposal sites in England and Wales, sharps that are not contaminated with medicinal products only |
Clinical waste, sharps, infectious, non‐medicinally contaminated, from non‐healthcare activities suitable for alternative treatment | For producers in Northern Ireland and Scotland whose waste is disposed of in those countries, both sharps that are not contaminated with medicinal products, and fully discharged medicinally contaminated sharps (other than cytotoxic and cytostatic) | |||
Sharps, medicinally contaminated, other than cytotoxic and cytostatic | Clinical waste, mixed sharps and pharmaceutical waste (not cytotoxic and cytostatic), infectious, for incineration only | Clinical waste incineration | This may include associated vials, bottles and ampoules of medicine | |
Sharps, contaminated with cytotoxic and cytostatic medicines |
Purple‐lidded, yellow sharps box | Clinical waste, mixed sharps and cytotoxic and cytostatic waste, infectious, for incineration only | Clinical waste incineration | This may include associated vials, bottles and ampoules of cytotoxic and cytostatic medicines |
Other infectious waste contaminated with cytotoxic and cytostatic medicines |
Purple‐lidded, rigid yellow container and sack | Clinical waste, cytotoxic and cytostatic waste, infectious, for incineration only | ||
Cytotoxic and cytostatic medicines (in original packaging) |
Two purple‐lidded, rigid yellow containers (one for solids, one for liquids) | Clinical waste, cytotoxic and cytostatic medicines from animal/human healthcare for incineration only | Clinical waste incineration | 20 01 31* is for separately collected municipal fractions (ie out‐patient returns to pharmacies) |
Cytotoxic and cytostatic medicines (not in original packaging) |
Two purple‐lidded, rigid yellow containers (one for solids, one for liquids) | |||
Other medicines (in original packaging) |
Two blue‐lidded, rigid yellow containers (one for solids, one for liquids) | Clinical waste, medicines (not cytotoxic and cytostatic) from animal/human healthcare, for incineration only | Clinical waste incineration | 20 01 32 is for separately collected municipal fractions (ie out‐patient returns to pharmacies) |
Other medicines (not in original packaging) |
Two blue‐lidded, rigid yellow containers (one for solids, one for liquids) | |||
Dental amalgam |
Leak‐proof rigid container with Hg suppressant | Dental amalgam and mercury including spent and out‐of‐date capsules, excess mixed amalgam and contents of amalgam separators | Recovery | Where teeth containing amalgam are present, H9: Infectious (see DH [25]) may also apply |
Photographic (X‐ray) wastes | X‐ray fixer | Recovery or treatment | ||
X‐ray developer (water based) | Recovery or treatment | |||
Photographic (X‐ray) wastes (contd) | Lead foil | Recovery | ||
X‐ray film containing silver | Recovery | |||
Gypsum and plaster‐cast wastes | Non‐infectious gypsum and plaster waste from healthcare | Gypsum recovery or specialist landfill in separate gypsum cell | See supporting text under ‘Gypsum and plaster casts’ (see DH [25]) for advice on the small proportion of this material that may be infectious and clinical waste | |
Radioactive waste | Healthcare waste contaminated with radioactive material | UN number will depend upon isotope. Radioactivity takes precedence for transport class when above the lower threshold | Incineration in hazardous waste incineration facility subject to Radioactive Substances Act (RSA) |
Notes:
The information in this table should be used where the assessment framework in ‘Healthcare waste definitions and classifications’ has identified that it is applicable to the waste in question. | |
a | The three entries are generic and will not be appropriate for all cytotoxic and cytostatic medicines. Some waste medicines will have to be classified in accordance with the provisions of ADR. In most cases a safety data sheet (SDS) for the medicines should show the appropriate transport classification. If this is not available, advice from a DGSA should be sought. |
b | The waste must be disposed of, or recovered, at a suitably authorised facility. |
Clinical governance
The producer of hazardous waste is legally responsible for that waste, and remains responsible for it until its final disposal by incineration, alternative treatment or landfill (DH [25]). In order to track waste to its point of origin, for example if it is necessary to identify where waste has been disposed of into the wrong waste stream, healthcare organizations should have a system of identifying waste according to the ward or department where it is produced. This may be through the use of labelling or dedicated waste carts for particular areas. When assembling sharps bins, always complete the label on the outside of the bin, including the date and the initials of the assembler. When sharps bins are closed and disposed of, they should be dated and initialled at each stage (DH [25]).